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Biomedical subjects

D Lewis

Publications and source records attributed to D Lewis.

At least 181 records · Page 10Linked to original sources
PubMed1993

Adult day care centres in British Columbia: client characteristics, reasons for referral and reasons for non-attendance.

This paper discusses a 1989 study of new admissions to 22 adult day care centres in British Columbia and compares it to similar studies in the U.S. The B.C. study investigated clients' characteristics, reasons for referral to the centres, and why some referrals did not attend. Of the new admissions, 63% were female and 30% lived alone. Compared to those in American studies, B.C. clients were older and more likely to live with a spouse. The primary medical conditions of B.C. clients were related to diseases of the circulatory system. As for daily activities, 58% could not bathe without supervision and 43% required assistance with dressing. Some 37% were unable to prepare their own meals; 31% needed help with housekeeping and 62% with shopping. The proportion of clients with mental diseases (38%) was similar to that in American adult day care centres. The three most common reasons for referring clients to adult day care centres were: to assist those who were socially isolated; to give family caregivers some respite; and to give clients emotional help. Perceptions varied as to why referred clients did not attend: for continuing care staff there were psychosocial factors; for adult day care staff it was related to characteristics of the service delivery system; and clients themselves cited functional, physical and operational factors (e.g., problems related to hearing and vision, transportation or physical barriers).

Activities of Daily Living↗
PubMed1993

Kaposi's sarcoma after alpha-interferon treatment for HIV-negative T-cell lymphoma.

A 54-year-old HIV-negative patient suffering from T-cell lymphoma of Lennert's lymphoma (Lel) type was treated for 13 months with interferon alpha-2b. While on treatment with interferon the patient demonstrated suppression of total and CD4+ lymphocytes to levels < 0,5 and 0,2 x 10(9)/l, respectively. Although interferon was successful in controlling the lymphoma the clinical course was complicated by the rapid development of aggressive, fatal Kaposi's sarcoma shortly after cessation of interferon treatment. It is suggested that the immunosuppressive effect of interferon therapy (or the T-cell lymphoma or both) may have played a role in the development of Kaposi's sarcoma as a second malignancy.

Female↗
PubMed1993

Adult Day Care centres in British Columbia: models, characteristics and services.

Adult Day Care (ADC) is increasingly being recognized as an important sub-system of the continuing care system. This paper reviews models developed in the United States and Britain and compares them, and the services they offer, with centres in British Columbia, Canada. Data on British Columbia are from a study in which all 49 centres in the province provided detailed information about their staffing, operating characteristics, activities and services. The study found B.C. compared favourably in providing services needed by ADC clients. Key differences between the B.C. centres and those in the U.S. and U.K. were: a larger proportion of B.C. centres were not affiliated with any other organization; B.C. centres admitted a range of clients and were less likely to cater exclusively to special needs groups; and, B.C. centres were more likely than centres in the U.S. to provide a number of services such as: dental care, transportation, bathing and physiotherapy.

Adult↗
PubMed1993

[Quality of life following liver transplantation].

247 liver transplantations in 210 patients were done between June 1983 and April 1991 in our hospital. In this paper we have analyzed our experience with adult liver transplantation from the view point of quality of life after liver transplant. Indications for liver transplantation were the following: 46 patients with cirrhosis due to non A, non B hepatitis, 29 with alcoholic cirrhosis, 13 with hepatitis B, 34 with primary biliary cirrhosis, 26 with primary sclerosing cholangitis, 29 with acute hepatic necrosis, 10 with liver tumor, 13 with miscellaneous other diseases. Of the 210 patients, 125 are alive to date. One, three and five year survival rates (excluding perioperative death) of all patients were 80.2%, 70.6% and 65.45% respectively. The best rehabilitation is in 73 patients who are full time workers or full time students and in 16 patients who are homemakers. The degree of rehabilitation in these patients is very high: 6 patients died after achieving complete rehabilitation; 11 patients retired from employment after liver transplantation; 8 patients are chronically disabled; 79 patients died before rehabilitation could be achieved. Rehabilitation rates of one and five year survivors are 78% and 84.2% respectively. Quality of life has been satisfactory following liver transplantation.

Adolescent↗
PubMed1993

Methotrexate therapy in rheumatoid arthritis: a life table review of 587 patients treated in community practice.

To determine whether methotrexate (MTX) maintains its effectiveness in rheumatoid arthritis (RA) in the setting of community based private rheumatology practice we used life table analysis to review the combined experience of a group of these practices. Of 587 patients with RA who started to take MTX, total termination rate at 70 months was 24.4% with most terminations prompted by drug toxicity. Older age (greater than 65 years) was associated with higher rates of toxicity. Treatment termination rates varied substantially between rheumatologists. We conclude that MTX therapy for RA is well tolerated and maintains effectiveness for at least 70 months.

Adult↗
PubMed1992

Hawkinsinuria in two families.

Hawkinsinuria, a disorder of tyrosine metabolism has been documented in two families in the United States, in one of which there was clear evidence of autosomal dominant inheritance. Metabolic acidosis and failure to thrive appear to be confined to infancy. Tyrosyl metabolites and 5-oxoproline are also found only in infancy, while 4-hydroxycyclohexylacetic acid was present only with time. The disease may be detected by organic acid analysis or by staining an electropherogram for sulfur containing compounds.

Acidosis↗
PubMed1992

Coupled expression of Ca2+ transport ATPase and a dihydrofolate reductase selectable marker in a mammalian cell system.

Stable expression of a full-length cDNA encoding chicken fast muscle Ca2+ transport ATPase was obtained in a Chinese hamster lung cell line (DC-3F), using a dual-promoter expression vector (pH beta FCaA3) in which the ATPase was cloned downstream of a human beta-actin gene promoter, and a mutant dihydrofolate reductase cDNA (A3/DHFR) was cloned downstream of an SV40 promoter-enhancer. Owing to its essentially normal catalytic activity and modest (20-fold) resistance to the antifolate methotrexate (MTX), the A3/DHFR mutant enzyme served as an efficient dominant selection marker in transfected cell populations challenged with MTX and, within a broad range of drug concentrations, allowed subsequent amplification and overexpression of vector sequences. In stable transfectants, the expressed ATPase was targeted to intracellular membranes, and the microsomal fractions from those cells exhibited high rates of Ca2+ transport. In comparative experiments using transient expression in COS1 cells, the level of ATPase per transfected cell was greater, but less than 5% of the transfected population exhibited ATPase expression. Furthermore, as opposed to the stable lines, the transiently expressing cells could not be propagated. Overall, the yield of ATPase was 12-16 and 4-6 micrograms per milligram of microsomal protein in the stable and the transient expression systems, respectively. The advantages of the stably transfected cell lines therefore lie in the homogeneity of ATPase expression and its distribution in cells and microsomes, in the large yield of microsomes obtained by continuous cell propagation, and in the reproducible functional characteristics of the microsomes. Moreover, the microsomes derived from stably transfected cell lines provide a convenient system for studies of Ca2+ transport and ATPase partial reaction, eliminating the need to conduct repetitive transient transfections to obtain sufficient amounts of enzyme for functional studies.

Animals↗
PubMed1992

Construction of a dominant selectable marker using a novel dihydrofolate reductase.

Simian virus 40 promoter-enhancer-based mammalian expression plasmids using dihydrofolate reductase (DHFR)-encoding cDNA sequences originally isolated from two methotrexate (MTX)-resistant, DHFR-overproducing Chinese hamster lung cell lines were constructed. One, designated pSVA75, contains a DHFR cDNA that encodes leucine (Leu22) and corresponds to the wild type (wt), MTX-sensitive form of the enzyme [Melera et al., J. Biol. Chem. 263 (1988) 1978-1990]. The other plasmid, pSVA3, contains a cDNA that encodes a novel mutant form of the enzyme in which Leu22 has been changed to Phe [Melera et al., Mol. Cell Biol. 4 (1984) 38-48]. The resulting DHFR displays a 20-fold-enhanced resistance to inhibition by MTX, but maintains the catalytic activity of the wt enzyme [Albrecht et al., Cancer Res. 32 (1972) 1539-1546]. Transfection of DHFR- Chinese hamster ovary cells with either plasmid demonstrated that both were able to reconstitute the DHFR+ phenotype with equal efficiency (i.e., greater than 2.5 x 10(-3), indicating that both the wt and mutant enzymes were catalytically active in transfected cells. In addition, the mutant form of the enzyme was found to act as a dominant selectable marker when transfected into diploid DHFR+ cells, and to allow selection of resistant clones at low MTX concentrations (125 nM MTX) with a frequency of greater than 8 x 10(-4). Moreover, transfected clones were found to amplify their exogenous DHFR sequences to reasonably high levels (42-fold) at relatively low (888 nM) MTX concentrations, suggesting that substantial amplification of DHFR DNA and cotransfected sequences as well, can be achieved with this vector.

Animals↗
PubMed1992

When should a synthetic casting material be used in preference to plaster-of-Paris? A cost analysis and guidance for casting departments.

An accurate cost analysis of the use of one of the new synthetic casting materials (Cellacast) compared with plaster-of-Paris (Gypsona) was undertaken over a 3-month period in the fracture clinic of Cardiff Royal Infirmary. The mean duration of usage before failure for synthetic forearm, scaphoid and below-knee casts was found to be approximately twice that of plaster casts. The use of synthetic casting materials was found to be cost-effective in situations where there was thought to be a high probability that structural failure of the cast would occur. Guidelines for the use of plaster-of-Paris and synthetic casting materials are presented.

Calcium Sulfate↗
PubMed1992

Congestive heart failure: survival trial of antiarrhythmic therapy (CHF STAT). The CHF STAT Investigators.

This study is a prospective, double-masked, randomized, clinical trial to determine the effect of anti-arrhythmic drug therapy on mortality in patients with congestive heart failure and ventricular arrhythmia. Patients will be assigned to receive either amiodarone or placebo. Eligible patients include those with ischemic and nonischemic congestive heart failure (New York Heart Association class III or VI) and with 10 or more ventricular premature beats per hour. All patients must have shortness of breath with minimal exertion or paroxysmal nocturnal dyspnea, a left ventricular internal dimension (LVIDd) by echocardiogram of 55 mm or greater (> or = 55 mm) or a CT ratio of greater than 0.5, and an ejection fraction of 40% of less. Patients will be entered into the study for 2.5 years and followed for an additional 2 years. Drug therapy will be continued for all patients throughout the entire study unless adverse reactions occur that necessitate individualized treatment. The expectation is that 674 patients are to be entered into the study from 25 participating centers. This sample size will allow for the detection of a 33% decrease in 2-year mortality (20% vs. 30%) in the treated patients as compared to those in the placebo group with a power of 0.90 and a two-sided alpha level of 0.05. Intermittent Holter monitoring, radionuclide ventriculograms, pulmonary function tests, echocardiograms, and blood tests, including arterial blood gases, will be required for each patient. The study analysis will address differences in total mortality, cardiac mortality, and sudden cardiac death between patients receiving anti-arrhythmic drug therapy and those receiving placebo. Other factors to be examined include the effects of antiarrhythmic therapy on suppression of arrhythmias, on ejection fraction, and relation of ischemic events to mortality.

Amiodarone↗
PubMed1992

Risk of viral hepatitis among military personnel assigned to US Navy ships.

A prevalence study of 2072 male US shipboard military personnel scheduled for deployment to South America/West Africa and the Mediterranean was conducted to determine whether serologic evidence of prior hepatitis A, B, or C infection is associated with exposure in foreign countries. There were 210 subjects (10.1%) who had antibodies to hepatitis A virus (anti-HAV), 76 (3.7%) to hepatitis B core antigen (anti-HBc), and 9 (0.4%) to hepatitis C virus (anti-HCV). By multivariate analysis, anti-HAV seropositivity was independently associated with age, non-white racial/ethnic groups, birth outside of the United States, and prior Caribbean deployment for less than 1 year. Anti-HBc seropositivity was independently associated with black and Filipino race/ethnicity, foreign birth, a history of a sexually transmitted disease, South Pacific/Indian Ocean deployment (less than 12 months), and South Pacific or Mediterranean duty for (greater than 1 year). No geographic risk factors were associated with anti-HCV positivity. These data indicate that military personnel deployed outside the United States are at increased risk of viral hepatitis infection and should be considered for vaccination.

Adult↗
PubMed1992

The use of DiI-marked hepatocytes to demonstrate orthotopic, intrahepatic engraftment following hepatocellular transplantation.

A novel method is described for marking primary hepatocytes with the fluorescent dye DiI prior to hepatocellular transplantation and identifying these cells within the hepatic parenchyma of recipient animals by fluorescence microscopy and flow cytometry. Optimal conditions are described for marking cells with DiI in suspension or in monolayer cultures prior to transplantation. DiI is shown to be nontoxic to hepatocytes and not to be exchanged between adjacent cells in vitro. Histological analysis of transplanted tissues shows DiI staining of engrafted hepatocytes and phagocytotic cells (Kupffer cells). This analysis shows that hepatocytes engraft within the hepatic parenchyma and exhibit a histological appearance indistinguishable from normal by conventional hematoxylin and eosin staining. Many previous reports of hepatocellular transplantation have been limited by their inability to unequivocally identify transplanted cells within the liver. These data illustrate the importance of having specific markers for transplanted cells that engraft in an orthotopic location and assume a normal morphological appearance.

Animals↗
PubMed1992

Anaemia, iron-related measurements and erythropoietin levels in untreated patients with active leprosy.

The mechanisms responsible for anaemia in leprosy were studied prior to the institution of therapy in 56 patients with active disease. Haematological indices, iron-related measurements, inflammatory markers and erythropoietin levels were assessed, with bone-marrow studies being performed on anaemic patients. Anaemia was more common in the patients with lepromatous leprosy (85.7%) than it was in the rest of the group (19%). The lepromatous group exhibited the disordered iron transport of the anaemia of chronic disorders in that they had a significantly lower mean serum iron level (P less than 0.05), and a mildly raised serum ferritin concentration. Anaemic lepromatous patients also showed a blunted erythropoietin response compared with controls with non-inflammatory anaemia. A subgroup of five anaemic subjects displayed apparently adequate transport of iron to the erythroid marrow (normal percentage transferrin saturations and appropriate sideroblast counts) and the blunted erythropoietin response appeared to be the dominant factor in the pathogenesis of their anaemia. Analysis of inflammatory markers revealed that while the erythrocyte sedimentation rate was very high in the lepromatous subjects, there was no concomitant rise in C-reactive protein concentration. This suggests the presence of a disordered cytokine-mediated acute phase response in the condition.

Adolescent↗